What Is Hyperemesis Gravidarum?

Women with prolonged hyperemesis gravidarum have a greater risk of preterm labor and preeclampsia.

Morning sickness is a common symptom of pregnancy, with 70 to 80 percent of pregnant women experiencing some form of it, according to the American Pregnancy Association (APA).

However, when the sickness is so extreme that it causes severe nausea, vomiting, and weight loss during pregnancy, it may be diagnosed as hyperemesis gravidarum.

Hyperemesis gravidarum usually continues beyond the first trimester and may stop by 21 weeks of pregnancy, but it can last the entire pregnancy in some women who experience the condition, according to the Hyperemesis Education & Research (HER) Foundation.

According to the APA, around 60,000 cases of hyperemesis gravidarum are treated in U.S. hospitals each year. But the number of diagnosed cases could be even higher, since some women may be treated at home or in a doctor's office.

Causes

While there is no proven cause of hyperemesis gravidarum, there are new theories that emerge each year.

Possible causes or contributing factors include the following:

Rising levels of hormones, such as human chorionic gonadotropin (HCG), estrogen, and progesterone early in pregnancy

Increase in blood thyroxine levels, which has been documented in 70 percent of hyperemesis gravidarum cases, according to the HER Foundation

A multiple pregnancy (twins, triplets, etc.)

Abnormal tissue growth in the uterus, called a hydatidiform mole

Regurgitation of the contents of the duodenum (upper small intestine) back into the stomach

Abnormalities of peristalsis (the way the gastrointestinal tract moves content along)

Liver abnormalities

Abnormalities of fat in the blood

Inner ear problems

Infection with Helicobacter pylori, or H. pylori (the organism that causes stomach ulcers)

Deficiency of the nutrients pyridoxine and zinc

Hyperemesis gravidarum may lead to the following symptoms and conditions:

Severe nausea and vomiting

Dizziness, lightheadedness, and fainting

Increased salivation

Anemia

Headaches

Confusion

Yellowing of the skin and eyes (jaundice)

Low blood pressure

Rapid heart rate

Overactive thyroid or parathyroid

Dehydration and production of ketones (sometimes leading to breath that smells "fruity")

Nutritional deficiencies

Metabolic imbalances

Increased sense of smell

Distorted sense of taste

Loss of skin elasticity

Loss of over 5 percent, and usually over 10 percent, of pre-pregnancy body weight

Risk Factors

The following factors may increase your chances of getting hyperemesis gravidarum:

Having the condition during a previous pregnancy

Being overweight

Having a multiple pregnancy

Being pregnant for the first time

Having trophoblastic disease (abnormal growth of cells inside the uterus)

Family history of other women developing the condition

Treatment

If you have severe symptoms of hyperemesis gravidarum, you may need to be hospitalized. Otherwise, you may be able to seek treatment at home or at a doctor's office.

While the course of treatment for hyperemesis gravidarum varies from person to person, your doctor may recommend one or more of the following:

Preventive measures, such as vitamin B6, ginger, peppermint, or a pressure-point wristband to help with nausea

Small, frequent meals that include dry, bland foods such as crackers

Intravenous fluids to help with dehydration

For severe cases, total parenteral nutrition, in which an intravenous (IV) solution of nutrients is given as a substitute for food

Medicine to prevent nausea, such as Phenergan (promethazine), Antivert (meclizine), or Inapsine (droperidol), doxylamine-pyridoxine (Diclegis), or metoclopramide (Reglan) which may be taken orally, by IV, or as a suppository

Complementary and alternative therapies, such as massage, acupuncture, acupressure, and hypnosis

Complications

The main risks to women with hyperemesis gravidarum are dehydration and electrolyte imbalances.

Women with prolonged hyperemesis gravidarum are at greater risk for preterm labor and preeclampsia, according to the HER Foundation.

Long-term complications to the baby may occur if the condition is left untreated, if the mother does not gain sufficient weight during the second half of pregnancy, and if the baby becomes malnourished.

Less common but severe complications of hyperemesis gravidarum include: